Thoracic and Abdominal Trauma

[Ronald Gross]

Given the instability of the patient, and the profound acidosis and
hemoperitoneum, I think you decided on the ideal treatment?

Was your anesthesiologist a Christian Scientist?  Or did he/she just
pray for devine intervention?

Ron

>>> navin goyal <drnavingoyal at yahoo.co.in> 8/23/2006 12:11 PM >>>
A 35 yr old male came to our Trauma centre, 5 hrs after a road traffic
accident (referred from peripheral centre)in condition of shock , drowsy
state, with tachypnoea , feeble pulse, BP on lower side , and large
bruise mark on the left chest and abdomen.Air entry was decreased  on
the left lower chest Iand guarding and tenderness was present in the lt.
hypochondrium and epigastrium . Immediate intuabation and ventilation,
Chest tube drainage , Oxygen support , Intravenous Fluid was given .
FAST showed Moderate hemoperitoneum .After resuscitation ( 0.5 hr)
patient showed improvement , BP - 120/80 , Pulse -130/min. Decision for
Laparotomy was taken and ABG sent . ABG showed ph-6.8/ pco2- 57.5/ p02-
278.3/ HCO3- 7.5.
  My anaesthetist was shocked to see this and said to wait till his
acidosis improves and I as a Surgeon wanted to do laparotomy as quick as
possible so that he has least blood loss and we both gave long reason to
justify ourselves.
   
  What should be the ideal way to treat this patient?
   
  Dr Navin Goyal 
  Trauma Fellow
  LTM Medical College, Sion
  Mumbai, INDIA

 				
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